Endometriosis diagnosis should be done in early stages

Here are ways that parents can support their young daughter dealing with the pain:

♦    Get good information about the pelvic pain.

♦    Help them cope up with the pain and its effects on their emotional thought process, so that they know they are not alone and do not need to suffer like this whole life.

♦    Help them develop a support team of gynecologists, physiotherapists, pain management specialists, dieticians, counsellors, friends, teachers and school nurses.

♦    Try to shift the focus away from pain by encouraging them to engage in activities that lift their spirits.

♦    Help your adolescent develop a plan to deal with 'a bad pain day'. 

Endometriosis is a condition in women where cells, similar to the lining of the uterus, grow an extra-uterine layer at an unusual site, such as ovaries, pelvic peritoneum, fallopian tubes. Actually, they can grow anywhere. In the past it was believed that this disease affects only older women, but we now know that it is common for a teen or young woman to also get endometriosis. A young girl may think that the incapacitating symptoms are the norm, and she has to live with it. This feeling and misconception is deepened further by ill-informed people who tell her that "period pain is normal", "exercise will make it better", "don't behave like a kid, it's your period", "your mother and grand-mother had the same pain, so don't worry".

If the pain does not subside and she is taken to a doctor, in all probability she may be told that there is no problem - "Everything is fine with you, no need to complain so much". If pain is rather bad, she will be introduced to the world of analgesics (painkillers). If that also does not work, contraceptive pills come to rescue, and she starts functioning under the influence of hormones. But, if it is due to endometriosis the disease progression continues, and after years of suffering, she may be diagnosed only once she undergoes laparoscopy.

Can women in their teens get endometriosis symptoms?

Most women, when asked, say that their period pain started in their teens or early 20s. Around 40% of women start experiencing period pain before the age of 15 years.

How does one recognize whether the period pain needs further evaluation?

Mild discomfort on the first 1-2 days of a period is common, but it needs further evaluation if it causes distress or inability to do routine activities, missing school, sports activities and does not get better when treatments like simple painkillers are taken.

Which teens are at greater risk?

Endometriosis runs in families, so young girls whose relatives have had endometriosis, have a higher chance of having endometriosis. Girls who start their periods early and have low BMI, run a higher risk of endometriosis.

These girls may even develop some other symptoms - such as heavy bleeding, bloating, lower back pain, muscle spasm, irritable bowel, painful overactive bladder, fatigue. If a teenage girl is not responding to medical pain management, and if a laparoscopy is done, almost 67-70 % of them will be diagnosed to have endometriosis.

How is endometriosis diagnosed in teenage girls?

An ultrasound and MRI can detect ovarian cysts quite well, but in teenage girls these lesions are rare and peritoneal lesions are more common. These lesions are small and are clear, or white or red, and can be picked up only on a laparoscopy. To identify these lesions properly, endo excision experts should be involved for diagnosis and treatment.

What can adolescents do to manage their pain and symptoms?

Keeping active which will reduce their muscle spasm. Gentle exercise such as walking and stretching helps. Physiotherapists can help relax pelvic muscles, as tightening the pelvic muscles increases pain. Improve diet, include anti-inflammatory diet and avoid constipation, drink plenty of water. Involving yourself in a hobby helps distract you from symptoms. Meditation and breathing exercises also focus the mind away from pain symptoms, and help in pain management. Acupuncture and alternative therapies can ease the pain symptoms for some young women.

What's best we can offer?

Ensure that it is diagnosed early. If the pain is severe, endometriosis should be considered a possibility. Opt for a diagnosis and believe the patient who is experiencing the pain. Do not keep suggesting that - "It happens … it's normal … you are over-reacting". If it's endometriosis, it can be corrected surgically, and she can lead a pain free life.

(The author is a Consultant at Obstetrics & Gynecology, Apollo Cradle & Children's Hospital)